RHEUMATISM, a term which has been and still is, rather vaguely and ex tensively used in the nomenclature of disease. But there is one very definite affection to which it is always applied; after this has been discussed the other senses in which it is used will be con sidered.
Acute rheumatism or rheumatic fever is indicated by general febrile symptoms, with redness, heat, swelling, and usually very intense pain, in and around one or more (generally several, either simul taneously or in succession) of the larger joints, and the disease shows a tendency to shift from joint to joint or to certain internal serous membranes, especially the pericardium and the endocardium; rheumatism being the most common ori gin of pericarditis, as has been already shown in the article on that disease.
The usual exciting cause of acute rheu matism is exposure to cold, and espe cially to cold combined with moisture, and hence the greater prevalence of this disease among the poor and ill-clad. Rheumatism is not, however, a universal sequence of exposure to the cold. It only occurs when there is a special predis position, or, as it is termed, a rheu matic diathesis or constitution, and the diathesis may be so strongly developed as to occasion an attack of acute rheu matism, independently of exposure to any apparent exciting cause. Men are more subject to the disease than women, but this probably arises from their greater exposure to atmospheric changes on ac count of the nature of their occupations, The predisposition is certainly affected by age; children under 10 years being comparatively seldom attacked, while the disease is most prevalent between the ages of 15 and 40. Above this age a first attack is rare, and even recurrences are less frequent than earlier in life. Per sons once affected become more liable to the complaint than they previously were. The disease is hereditary in a consider able proportion of cases. The exact nature of the disease poison is unknown.
In the great majority of cases acute rheumatism ends in recovery; and j per manent damage to the affected joints is rare. It is, however, extremely apt to recur, either in the early stages of con valescence, or after an interval of months or years. The chief danger arises from implication of the heart, which frequently occurs. The younger the patient the greater the liability to these complications, which usually re sult in more or less permanent impair ment of the heart's action. Another con
dition, much less common, but extremely fatal, is known as rheumatic hyperpy rexia, and is characterized by a very rapid rise of temperature to 108° or 110°, with head symptoms in the form either of drowsiness or of violent de lirium.
The patient should be strictly confined to bed between blankets (i. e., without sheets), and be clothed in flannel; he must be carefully protected from draughts, and from undue pressure of the bed clothes, and supplied with light nourishment and diluent drinks. Under such conditions, without other treatment, most cases recover in the course of time. Till the last quarter of the 19th century there was no general agreement as to what more should be done. In 1876 Stricker in Berlin and Maclagan in Eng land called attention to a new method of treatment. This method consists in the administration of salicin, or of one of its derivatives (salicylic acid, salicylate of soda, etc.). In rheumatic hyperpyrexia the only treatment that has been found effectual is immersion in a tepid bath as often as the tempera ture rises to a dangerous point. Con valescence is usually very slow, and it is necessary to keep the patient in bed and on low diet for some time after the fever has disappeared to diminish the tendency to relapse. At this stage tonics, especially quinine and iron, are generally useful.
Chronic Rheuntatism.—Chronic painful affections of the joints sometimes fol low rheumatic fever and are clearly a consequence of it. The name is often erroneously applied to chronic and in sidious forms of gout. There is another form of disease to which most of the cases of so-called "chronic rheumatism" belong, probably distinct from both rheu matism and gout, popularly so called, though it is often called "rheumatic gout," which deserves separate mention.
Osteo-arthritis (chronic rheumatic ar thritis and rheumatic arthritis are among its many other names) is char acterized in most cases by a very chronic course, by pain and stiffness in one or more of the joints, with creaking on movement, and by destructive changes of the cartilages of the affected joints, with enlargpment of the ends of the bones in their neighborhood. It is more common in women than in men; most often be gins at or after middle life, though oc casionally even in childhood.
Muscular rheumatism is the name usually given to painful affections of the muscles for which no clear cause is dis coverable.